Birth asphyxia is a major cause of newborn death and brain injury. When a newborn is unable to breathe, or has limited ability to breathe, medical personnel must act quickly. Typically, medical personnel will perform rescue breathing (sometimes referred to as “basic resuscitation”, “manual resuscitation”, or “bag-and-mask” rescue breathing). In general terms, rescue breathing is a procedure in which positive pressure ventilation is used to help a patient breathe. In one type of procedure, a bag-valve mask is placed over the patient's nose and mouth. The “bag” portion of the bag-valve mask consists of a flexible chamber that is compressed or squeezed by hand to force gas out of a first end of the bag and into the patient's lungs. When the bag is released, the bag self-inflates with either ambient air or oxygen gas that enters through a second end of the bag. While the bag self-inflates, the patient's lungs can expel gas to the ambient environment.
Medical professionals and emergency personnel must have proper training to perform effective rescue breathing. Effective rescue breathing is particularly challenging when the patient is a newborn. Many times, medical personnel monitor the newborn's rescue breathing by confirming chest wall movement. Confirming chest wall movement can be very difficult, however, even if the clinician is very experienced.
Effective rescue breathing is also made difficult by the number of parameters that must be monitored at one time. A clinician must squeeze the bag at an appropriate rate to provide an adequate respiratory rate. Therefore, the respiratory rate must be monitored and controlled. The clinician must also deliver an appropriate volume of air or gas into the patient's lungs. Too little volume will deliver an insufficient amount of oxygen, while too much volume can be unsafe for the patient. As such, tidal volume must be monitored and controlled. To complicate matters further, the clinician must also maintain a proper seal between the mask and the patient's face to ensure that gas being squeezed from the bag is delivered to the patient's lungs. A leak can be very difficult to detect and locate for the obvious reason that the leak is not visible.
Monitoring so many variables at the same time can be extremely difficult, particularly when only one person performs the rescue breathing. Often times, two individuals carry out the rescue breathing procedure so that the responsibilities are divided. One person might focus on holding the mask to maintain a proper seal, while the other person focuses on squeezing the bag to maintain an appropriate respiratory rate and volume. Unfortunately, it is not always possible to have two individuals on hand during a rescue breathing event. Even when two individuals are available, it is still very difficult to monitor so many parameters, identify when a problem occurs and address the problem in a short amount of time.